MEDICARE: STEVEN PAUL ELLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	25MA054450	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225031453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN PAUL ELLIS M.D.

Provider Business Mailing Address
First Line	:	123 FRANKLIN CORNER RD
Second Line	:	STE 207
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2526
Country	:	US
Telephone Number	:	609-896-9448
Fax Number	:	609-896-7052

Provider Business Practice Location Address
First Line	:	123 FRANKLIN CORNER RD
Second Line	:	STE 207
City	:	LAWRENCEVILLE
State	:	NJ
Zip	:	08648-2526
Country	:	US
Telephone Number	:	609-896-9448
Fax Number	:	609-896-7052

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/13/2009

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